Provider Demographics
NPI:1568748010
Name:ADVANCED RX MANAGEMENT
Entity Type:Organization
Organization Name:ADVANCED RX MANAGEMENT
Other - Org Name:ADVANCED RX 064
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-543-9041
Mailing Address - Street 1:3501 E FRONTAGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1704
Mailing Address - Country:US
Mailing Address - Phone:813-543-9041
Mailing Address - Fax:925-522-2930
Practice Address - Street 1:5315 AVION PARK DR STE 120
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1461
Practice Address - Country:US
Practice Address - Phone:813-543-9043
Practice Address - Fax:925-522-2930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
CAWLS 56553336M0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1568748010OtherNON-DISPENSING PHARMACY LOCATION
FL1568748010Other461529015